Findings:
Left side:
The left middle ear cavity shows near total opacification with associated opacity within the left external auditory canal, creating mass effect with bony erosions in the floor and anterior wall of the left external auditory canal. Superiorly the soft tissue density extends into the left mastoid antrum. Also, opacified sinus tympani, facial recess, anterior epitympanic recess, as well as both window niches are noted. The mastoid air cells are opacified and hypocellular. The tegmen tympani and scutum are intact.
Erosion of the long limb of incus and the lateral process and handle of malleolus is seen.
The course of the facial nerve is normal. The facial nerve canal shows possible dehiscence at inferior wall tympanic segment.
The vestibular-cochlear apparatus and internal acoustic canal have a normal appearance. The vestibular aqueduct is normal size.
Right side:
Soft tissue density material within the right tympanic cavity, mostly located in the epitympanic recess and in both window niches. Complete loss of ossification of the lateral process and handle of malleolus and partial loss of ossification of the long limb of incus is seen.
The right tympanic membrane is thickened and retracted with area of central perforation. Mild soft tissue thickening is seen along the roof of the right external auditory canal.
The Prussak space is clear with intact scutum.
The course of the facial nerve is normal.
Ossification of membranous labyrinth involving all the cochlear turns and vestibule with non-visualization of all the semicircular canals, indicating complete obliteration of the canals by the ossification.
Soft tissue density is seen within the fossa of vestibular window with widening and bony erosions of the vestibular window.
Partial obliteration of the mastoid process is seen on the right side.
The imaged paranasal sinuses are clear. Old nasal bone fracture is seen.
Conclusion:
Features likely in keeping with bilateral chronic suppurative otitis media with ossicular erosions and mass effect on the left side.
Additional soft tissue density with bony erosions within the left external auditory canal, suspicious of cholesteatoma. Clinical correlation and further evaluation with HASTE DW-MRI is advised.
Right-sided labyrinthitis ossificans with severe degree of ossification of right membranous labyrinth involving the cochlea, vestibule and semicircular canals.
Also, right-sided tympanic membrane perforation.